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Cheng M, Wang Z, Yu NN. Long-term mental health cost of the Great Chinese Famine. HEALTH ECONOMICS 2024; 33:121-136. [PMID: 37823589 DOI: 10.1002/hec.4762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/05/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
The Great Chinese Famine (1959-1961) claimed tens of millions of lives. This study aims to causally examine the long-term mental health cost it imposed on those who survived. To estimate the nationwide total mental health cost, we use a novel dataset to measure the famine intensity of every prefecture-level region, match it to a nationally representative survey, and then identify the long-term effects of the famine on the depression of rural residents then in the early years of their lives. Difference-in-differences estimates reveal that a one-standard-deviation rise in the experienced famine intensity increased a standard measure of depression by about 0.039 and 0.064 if the individual experienced the famine at ages 0-2 and 3-5, respectively. This translates into roughly 7.99 million cases of severe depressive symptoms caused by the famine, which is likely an undercount. Examining the mechanisms behind the large effects, we find that important roles were played by starvation experience and childhood maltreatment, as well as the primary mediators including other health outcomes, economic status, and social relationship. Our findings shed light on how large-scale food security failures impact the mental well-being of the survivors.
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Affiliation(s)
- Mingwang Cheng
- School of Economics and Management, Tongji University, Shanghai, China
| | - Zhouxiang Wang
- School of Economics, Anhui University, Hefei, Anhui, China
| | - Ning Neil Yu
- Institute for Social and Economic Research, Nanjing Audit University, Nanjing, Jiangsu, China
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Yue Q, Yang P, Ma X, Shu Z, Yang L, Wu Y, Tang Y, Luo X, Wu S, Li Y. The Mediating Role of Systemic Inflammation in the Effects of Fetal Famine Exposure on Cardiovascular Disease in Adults: A Cohort Study. J Nutr 2023; 153:1389-1397. [PMID: 36858258 DOI: 10.1016/j.tjnut.2023.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/25/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND A few studies have reported the association between famine exposure during fetal development and risk of CVD, but no mechanisms have been explored. OBJECTIVES The objective of this study was to examine risk of CVD in adulthood after exposure to famine during the fetal stage and explore the mediating role of systemic inflammation. METHODS A total of 59,416 participants of the Kailuan Study without CVD were included. All participants were divided into 3 groups based on date of birth, including the unexposed group (1963-1974), the fetal-exposed group (1959-1962), and the childhood-exposed group (1949-1958). Systemic immune-inflammation index (SII) (neutrophils × platelets / lymphocytes) and systemic inflammatory response index (SIRI) (neutrophils × monocytes / lymphocytes) are 2 novel systemic inflammation indexes that represent the level of systemic inflammation. Time-weighted Cox regression was used to test the effect of famine exposure on risk of CVD, and a mediation model was used to calculate the role of systemic inflammation. RESULTS During a median follow-up period of 12.36 (12.69, 13.16) y, a total of 3772 cases of CVD were documented. Compared with unexposed participants, the fetal-exposed group had an increased risk of CVD (HR: 1.19; 95% CI: 1.04, 1.38) and stroke (HR: 1.28; 95% CI: 1.09, 1.51) but not MI. No association was observed in the childhood-exposed group. In mediation analysis, SII mediated an estimated 24.43% of the association between fetal exposure and CVD (24.61% for stroke and 23.27% for MI). For SIRI, this percentage was 30.20% for CVD (29.94% for stroke and 31.25% of MI). CONCLUSIONS Fetal exposure to famine may increase risk of CVD in adulthood. Systemic inflammation may play an intermediary role in the effect of fetal famine exposure on CVD. J Nutr 2023;xx:xx-xx.
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Affiliation(s)
- Qing Yue
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Peng Yang
- Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Xiaoxu Ma
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Zhe Shu
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Ling Yang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yuntao Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yongmei Tang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xiaoyan Luo
- Department of Emergency, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China.
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, China.
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van Ewijk R, Lindeboom M. Selective mortality and fertility and long run health effects of prenatal wartime exposure. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101186. [PMID: 36379146 DOI: 10.1016/j.ehb.2022.101186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
Many previous studies have shown that prenatal exposure to adverse historical circumstances negatively affects long-run health. Most women who are pregnant during wars experience clearly adverse circumstances that are however not as harsh as the typically studied extreme episodes such as famines, combat and wide-scale destruction. We show that prenatal exposure to World War II (WWII) in five Western European countries did not lead to a population-wide poorer health among the elderly. We even find indications of a better than expected health. This is likely due to selective fertility and mortality. We attempt to quantify these selection effects and show that when taking them into account, the initially positively estimated health effects on almost all outcomes are substantially attenuated. Selective mortality and fertility likely occur in similar directions for many historical episodes of adversity. Our results therefore suggest that a part of the previous research on such exposures likely under estimated the true sizes of the long-run effects.
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Affiliation(s)
- Reyn van Ewijk
- Faculty of Law and Economics, Johannes Gutenberg-University Mainz, Germany.
| | - Maarten Lindeboom
- Department of Economics, Vrije Universiteit Amsterdam, The Netherlands; Centre for Health Economics, Monash University, Tinbergen Institute, IZA, Germany.
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When investment backfires: Unbalanced sex ratios and mental health among boys in rural areas. DEMOGRAPHIC RESEARCH 2022. [DOI: 10.4054/demres.2022.47.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
In 2020, China's population aged 60 or older exceeded 264 million, representing 25% of the global population in that age-group. Older adults in China experienced periods of dramatic political and social unrest in early life, as well as economic transformations leading to drastic improvements in living standards during adulthood and older age. However, the implications of life course socioeconomic status (SES) trajectories for healthy longevity in later life have not been systematically studied in China. We utilize data from the China Health and Retirement Longitudinal Study (CHARLS) to comprehensively investigate how early-life conditions and adult SES combine to influence healthy longevity in later life. We find that both childhood and adulthood SES are associated with late-life health. The largest disparities in life expectancy (LE) and disability-free LE are found between those with persistently low SES throughout life and those with consistently high SES. At age 45, the gap in total LE between the most advantaged and least advantaged groups is six years for men and five years for women. Despite China's major policy changes prioritizing equity in income and health care in recent decades, our findings suggest that dramatic health inequalities among older adults remain. Our findings extend the literature on the effect of socioeconomic patterns across the life course on gradients in later-life health and highlight continuing disparities in healthy longevity among older adults in China.
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Affiliation(s)
- Collin F Payne
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, Australia
| | - Kim Qinzi Xu
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, Australia
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Ding X, Li J, Wu Y, Yang P, Zhao D, Yuan X, Chen S, Luo X, Li Y, Wu S. Ideal Cardiovascular Health Metrics Modify the Association Between Exposure to Chinese Famine in Fetal and Cardiovascular Disease: A Prospective Cohort Study. Front Cardiovasc Med 2021; 8:751910. [PMID: 34805306 PMCID: PMC8599955 DOI: 10.3389/fcvm.2021.751910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background: No study has explored the modification effect of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and risk of cardiovascular disease (CVD) so far. We aim to examine the effect of ICVHMs on the association between exposure to famine early in life and the risk of CVD in adulthood. Methods: A total of 61,527 participants free of CVD were included in this study from the Kailuan Study. All participants were divided into three groups, included nonexposed, fetal-exposed, and childhood-exposed groups. Cox regression was used to estimate the effect of famine exposure and ICVHMs on CVD risk. Results: After a median of 13.0 (12.7–13.2) years follow-up, 4,814 incident CVD cases were identified. Compared with nonexposed participants, the CVD risk increased in participants with fetal famine exposure (hazard ratio [HR]: 1.21; 95% CI: 1.07–1.37), but not in childhood famine-exposed participants. After stratifying by the number of ICVHMs, the increased CVD risk associated with fetal famine exposure was only observed in participants with less ICVHMs ( ≤ 2) (HR: 1.30; 95% CI: 1.11–1.52, P for interaction=0.008), but disappeared in those with three or more ICVHMs. The modified effect of ICVHMs was sex specific (P for sex interaction = 0.031). Conclusions: Exposing to famine in the fetal period could increase the risk of CVD in late life; however, ICVHMs might modify the effect of famine exposure on CVD risk, especially in men.
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Affiliation(s)
- Xiong Ding
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Jinfeng Li
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Ying Wu
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Peng Yang
- Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Dandan Zhao
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xiaojie Yuan
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Xiaoyan Luo
- Department of Emergency, Kailuan General Hospital, Tangshan, China
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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Wang Z, Dong Y, Xu R, Wang X, Li Y, Zou Z. Early-Life Exposure to the Chinese Great Famine and Later Cardiovascular Diseases. Int J Public Health 2021; 66:603859. [PMID: 34744570 PMCID: PMC8565276 DOI: 10.3389/ijph.2021.603859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to examine the association between early life famine exposure and adulthood cardiovascular diseases (CVDs) risk. Methods: A total of 5,504 subjects were selected using their birthdate from national baseline data of the China Health and Retirement Longitudinal Survey to analyze the association between famine exposure in early life and CVDs risk in adulthood. CVDs was defined based on the self-reported doctor's diagnosis. Results: The prevalence of CVDs in the unexposed group, fetal-exposed, infant-exposed, and preschool-exposed groups was 15.0%, 18.0%, 21.0%, and 18.3%, respectively. Compared with the unexposed group, fetal-exposed, infant-exposed and preschool-exposed groups had higher CVDs risk in adulthood (p < 0.05). Compared with the age-matched control group, infancy exposed to famine had a significantly higher adulthood CVDs risk (OR = 1.52, 95% CI: 1.15, 2.01; p = 0.006). The association seems to be stronger among population with higher education level (P interaction = 0.043). Sensitivity analysis revealed consistent association between early-life famine exposure and adult CVDs risk. Conclusion: Early life exposed to the China great famine may elevate the risk of CVDs in adulthood.
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Affiliation(s)
- Zhenghe Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yanhui Dong
- School of Public Health and Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Rongbin Xu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Xijie Wang
- School of Public Health and Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yanhui Li
- School of Public Health and Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Zhiyong Zou
- School of Public Health and Institute of Child and Adolescent Health, Peking University, Beijing, China
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Yang Y, Wu J, Wang X, Yao J, Lao KS, Qiao Y, Xu Y, Hu Y, Feng Y, Cui Y, Shi S, Zhang J, Liang M, Pan Y, Xie K, Yan K, Li Q, Ye D, Wang Y. Circulating fibroblast growth factor 21 as a potential biomarker for missed abortion in humans. Fertil Steril 2021; 116:1040-1049. [PMID: 34167789 DOI: 10.1016/j.fertnstert.2021.05.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether serum levels of fibroblast growth factor 21 (FGF21) and fatty acid-binding protein-4 (FABP4) are associated with missed abortion (MA) in humans. DESIGN Cross-sectional study. SETTING University-affiliated hospital. PATIENT(S) Patients with MA at 8-12 weeks of gestation. INTERVENTION(S) None. MAIN OUTCOME MEASURES(S) Serum levels of FGF21 and FABP4 were tested by enzyme-linked immunosorbent assay. Placental samples were collected during dilation and curettage surgery, and the expression of FGF21 and its related genes were measured using quantitative polymerase chain reaction. RESULT(S) In the discovery cohort, 78 patients with MA and 79 healthy pregnant women matched for maternal age and body mass index were nested from a prospective cohort. Circulating levels of FGF21 and FABP4 were significantly and independently elevated in patients with MA relative to the levels in the healthy controls. A single measurement of FGF21 serum level effectively discriminated MA with an area under the receiver operating characteristics curve of 0.80 (95% confidence interval: 0.73-0.87). Importantly, in our external validation cohort that comprised subjects with MA (n = 34) or induced abortion (n = 27), the FGF21 serum levels achieved an area under the receiver operating characteristics curve of 0.85 (95% confidence interval: 0.75-0.96) when identifying those with MA. Nevertheless, expression of FGF21 in the placenta was not associated with its serum concentration. Placental tissues from patients with MA exhibited impaired FGF21 signaling. CONCLUSION(S) Our results suggested that serum levels of FGF21 and FABP4 were associated with MA. Circulating FGF21 may serve as a potential biomarker for the recognition of MA.
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Affiliation(s)
- Yongkang Yang
- The Second Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China; Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Jiaming Wu
- State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong SAR, People's Republic of China; Department of Medicine, the University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Xia Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Jianyu Yao
- Joint Laboratory between Guangdong and Hong Kong on Metabolic Diseases, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China; Guangdong Research Center of Metabolic Diseases of Integrated Western and Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Kim Shijian Lao
- Department of Pharmaceutical and Pharmacy, the University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yumei Qiao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Ying Xu
- School of Clinical Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Yue Hu
- State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong SAR, People's Republic of China; Department of Medicine, the University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yanhong Feng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Yanchao Cui
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Shuai Shi
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Jing Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Man Liang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Yong Pan
- School of Biomedicine Science, Shenzhen University, Shenzhen, People's Republic of China
| | - Kang Xie
- Joint Laboratory between Guangdong and Hong Kong on Metabolic Diseases, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China; Guangdong Research Center of Metabolic Diseases of Integrated Western and Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Kaixuan Yan
- Joint Laboratory between Guangdong and Hong Kong on Metabolic Diseases, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China; Guangdong Research Center of Metabolic Diseases of Integrated Western and Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Qin Li
- The Second Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China; Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Dewei Ye
- Joint Laboratory between Guangdong and Hong Kong on Metabolic Diseases, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China; Guangdong Research Center of Metabolic Diseases of Integrated Western and Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Yao Wang
- State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong SAR, People's Republic of China; Department of Medicine, the University of Hong Kong, Hong Kong SAR, People's Republic of China.
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Li S, Wang W, Zhang D, Li W, Lund J, Kruse T, Mengel-From J, Christensen K, Tan Q. Differential regulation of the DNA methylome in adults born during the Great Chinese Famine in 1959-1961. Genomics 2021; 113:3907-3918. [PMID: 34600028 DOI: 10.1016/j.ygeno.2021.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/24/2021] [Accepted: 09/25/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Extensive epidemiological studies have established the association between exposure to early-life adversity and health status and diseases in adults. Epigenetic regulation is considered as a key mediator for this phenomenon but analysis on humans is sparse. The Great Chinese Famine lasting from 1958 to 1961 is a natural string of disasters offering a precious opportunity for elucidating the underlying epigenetic mechanism of the long-term effect of early adversity. METHODS Using a high-throughput array platform for DNA methylome profiling, we conducted a case-control epigenome-wide association study on early-life exposure to Chinese famine in 79 adults born during 1959-1961 and compared to 105 unexposed subjects born 1963-1964. RESULTS The single CpG site analysis of whole epigenome revealed a predominant pattern of decreased DNA methylation levels associated with fetal exposure to famine. Four CpG sites were detected with p < 1e-06 (linked to EHMT1, CNR1, UBXN7 and ESM1 genes), 16 CpGs detected with 1e-06 < p < 1e-05 and 157 CpGs with 1e-05 < p < 1e-04, with a predominant pattern of hypomethylation. Functional annotation to genes and their enriched biological pathways mainly involved neurodevelopment, neuropsychological disorders and metabolism. Multiple sites analysis detected two top-rank differentially methylated regions harboring RNF39 on chromosome 6 and PTPRN2 on chromosome 7, both showing epigenetic association with stress-related conditions. CONCLUSION Early-life exposure to famine could mediate DNA methylation regulations that persist into adulthood with broad impacts in the activities of genes and biological pathways. Results from this study provide new clues to the epigenetic embedding of early-life adversity and its impacts on adult health.
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Affiliation(s)
- Shuxia Li
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Weijing Wang
- Qingdao University School of Public Health, Qingdao, China
| | - Dongfeng Zhang
- Qingdao University School of Public Health, Qingdao, China
| | - Weilong Li
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark; Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland.
| | - Jesper Lund
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark; Digital Health & Machine Learning Research Group, Hasso Plattner Institute for Digital Engineering, Potsdam, Germany.
| | - Torben Kruse
- Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jonas Mengel-From
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Kaare Christensen
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Qihua Tan
- Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark; Unit of Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Frail Males on the American Frontier: The Role of Environmental Harshness on Sex Ratios at Birth across a Period of Rapid Industrialization. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10090319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While sex ratios at birth (SRB) have been shown to vary within and across populations, after over a century of research, explanations have remained elusive. A variety of ecological, demographic, economic, and social variables have been evaluated, yet their association with SRB has been equivocal. Here, in an attempt to shed light on this unresolved topic within the literature, we approach the question of what drives variation in SRB using detailed longitudinal data spanning the frontier-era to the early 20th century in a population from the US state of Utah. Using several measures of environmental harshness, we find that fewer boys are born during challenging times. However, these results hold only for the frontier-era and not into a period of rapid economic and infrastructure development. We argue that the mixed state of the literature may result from the impact and frequency of exogenous stressors being dampened due to industrialization.
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Morse A, Luke N. Foetal loss and feminine sex ratios at birth in sub-Saharan Africa. POPULATION STUDIES 2021; 75:239-254. [PMID: 33599566 PMCID: PMC8833094 DOI: 10.1080/00324728.2021.1877793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/08/2020] [Indexed: 10/22/2022]
Abstract
A wealth of demographic research has explored the determinants of sex ratios at birth, but few studies have considered the role of foetal loss (spontaneous abortion), in producing feminine sex ratios. One challenge is measuring the occurrence of foetal loss, which is difficult to recognize and report in survey research. This study uses the length of the birth interval as a proxy for foetal loss; foetal loss restarts the clock on time to conception and lengthens the birth interval. We use Demographic and Health Survey data on second births to women in 17 sub-Saharan African countries. Results show that longer second birth intervals are significantly related to lower odds of a male second birth and to feminine sex ratios at birth. These findings suggest that high levels of foetal loss, which could signal underlying poor maternal health in a population, have dramatic effects on the sex ratio at birth.
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Affiliation(s)
- Anne Morse
- Department of Sociology and Criminology, The Pennsylvania State University, State College, PA, U.S
| | - Nancy Luke
- Department of Sociology and Criminology, The Pennsylvania State University, State College, PA, U.S
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An interaction between fetal sex and placental weight and efficiency predicts intrauterine growth in response to maternal protein insufficiency and gestational exposure window in a mouse model of FASD. Biol Sex Differ 2020; 11:40. [PMID: 32690098 PMCID: PMC7372829 DOI: 10.1186/s13293-020-00320-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Individuals exposed to gestational stressors such as alcohol exhibit a spectrum of growth patterns, suggesting individualized responses to the stressors. We hypothesized that intrauterine growth responses to gestational alcohol are modified not only by the stressor's severity but by fetal sex and the placenta's adaptive capacity. METHODS Pregnant C57BL/6J mice were assigned to one of three groups. Group 1 consumed a normal protein diet (18% protein by weight) and received 4.5 g alcohol/kg body weight (NP-Alc-8) or isocaloric maltodextrin (NP-MD-8) daily from embryonic day (E) 8.5-E17.5. Group 2 consumed the same diet but received alcohol (NP-Alc-13) or maltodextrin (NP-MD-13) daily from E13.5-E17.5. Group 3 consumed the same diet but containing a lower protein content (12% protein by weight) from E0.5 and also received alcohol (LP-Alc-8) or maltodextrin (LP-MD-8) daily from E8.5-E17.5. Maternal, placental, and fetal outcomes were assessed on E17.5 using 2-way ANOVA or mixed linear model. RESULTS We found that intrauterine growth differed in the alcohol-exposed fetuses depending on sex and insult severity. Both NP-Alc-8 (vs. NP-MD-8) males and females had lower body weight and asymmetrical growth, but only NP-Alc-8 females had lower placental weight (P < 0.05). NP-Alc-13 (vs. NP-MD-13) females, but not their male littermates, had lower body weight (P = 0.019). Alcohol exposure beginning from E8.5 (vs. E13.5) decreased the ratio of fetal liver-to-body weight and increased the ratio of fetal brain-to-liver weight in both sexes (P < 0.05). LP-Alc-8 (vs. NP-MD-8) group had smaller litter size (P = 0.048), but the survivors had normal placental and body weight at E17.5. Nevertheless, LP-Alc-8 fetuses still showed asymmetrical growth. Correlation analyses reveal a relationship between litter size and placental outcomes, which were related to fetal outcomes in a sex-dependent manner, suggesting that the placenta may mediate the consequence of LP-Alc-altered litter size on fetal development. CONCLUSIONS Our data indicate that the placenta is strongly involved in the fetal stress response and adapts in a sex-dependent fashion to support fetal development under the alcohol stressor. These variables may further influence the spectrum of intrauterine growth outcomes observed in those diagnosed with fetal alcohol spectrum disorder.
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Lv S, Shen Z, Zhang H, Yu X, Chen J, Gu Y, Ding X, Zhang X. Association between exposure to the Chinese famine during early life and the risk of chronic kidney disease in adulthood. ENVIRONMENTAL RESEARCH 2020; 184:109312. [PMID: 32151839 DOI: 10.1016/j.envres.2020.109312] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Famine exposure in human early life is proven to be associated with urinary protein concentration and renal function but has not been studied with chronic kidney disease. We aimed to explore the association between exposure to the Chinese famine (from 1959 to 1962) in early life and the risk of chronic kidney disease in adulthood. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We selected 6267 participants from the baseline survey of China Health and Retirement Longitudinal Study (CHARLS) 2011-2012. Based on the birth year, they were divided into fetal exposed, preschool exposed, school-aged exposed, and non-exposed groups. The estimated glomerular filtration rate (eGFR) was calculated according to Japanese coefficient-modified Chronic Kidney Disease Epidemiology Collaboration equation. Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min per 1.73 m2. RESULTS The prevalence of CKD in fetal exposed, preschool exposed, school-aged exposed and non-exposed groups was 4.27%, 5.41%, 9.65% and 2.42%, respectively. The risk of CKD in fetal exposed, preschool exposed and school-aged exposed groups was significantly higher than the non-exposed group. In addition, after stratification by gender and famine severity, we found that only fetal exposure to the severe famine was associated with the elevated risk of CKD among male adults (OR 4.44, 95%CI 1.10-17.92, P < 0.05), even after adjusting for age, marital status, household per capita income, history of kidney disease, hypertension, diabetes or abnormal glucose tolerance, smoking, drinking, rural/urban residence and highest educational attainment of parents. CONCLUSIONS Severe famine exposure as a fetus might increase the risk of chronic kidney disease in male adults.
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Affiliation(s)
- Shiqi Lv
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney Disease, Shanghai, China
| | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney Disease, Shanghai, China
| | - Han Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney Disease, Shanghai, China
| | - Xixi Yu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney Disease, Shanghai, China
| | - Jing Chen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yulu Gu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney Disease, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China; Shanghai Institute of Kidney and Dialysis, Shanghai, China.
| | - Xiaoyan Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney Disease, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China; Shanghai Institute of Kidney and Dialysis, Shanghai, China.
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Gomez-Verjan JC, Barrera-Vázquez OS, García-Velázquez L, Samper-Ternent R, Arroyo P. Epigenetic variations due to nutritional status in early-life and its later impact on aging and disease. Clin Genet 2020; 98:313-321. [PMID: 32246454 DOI: 10.1111/cge.13748] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 12/21/2022]
Abstract
Epigenetics refers to changes in gene function, not resulting from the primary DNA sequence, influenced by the environment. It provides a link between the molecular regulation of the genome and the environmental signals exposed during the life of individuals (including lifestyle, social behavior, development, and nutrition). Notably, early development (intrauterine or postnatal) is highly influenced by the adverse socioeconomic status that leads to malnutrition or obesity; these conditions induce changes over the fetal epigenetic programming and can be transferred by transgenerational inheritance, inducing alterations of the transcription of genes related to several metabolic and neurological processes. Moreover, obesity during pregnancy, and excessive gestational weight gain are associated with an increased risk of fatal pregnancy complications, and adverse cardio-metabolic, respiratory and cognitive-related outcomes of the future child. However, most of our knowledge in this field comes from experimental animal models, that partially resemble the nutritional effects of humans. In this context, nutritional effects implicated in historical famines represent valuable information about the transgenerational effects of undernutrition and stress. In the present review, we attempt to describe the most outstanding results from the most studied famines about the impact of malnutrition on the epigenome.
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Affiliation(s)
- Juan C Gomez-Verjan
- División de Ciencias Básicas, Instituto Nacional de Geriatría (INGER), Mexico City, Mexico
| | | | - Lizbeth García-Velázquez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Rafael Samper-Ternent
- Geriatric/Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Pedro Arroyo
- División de Epidemiología, Instituto Nacional de Geriatría (INGER), Mexico City, Mexico
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Li Y, Li Y, Gurol ME, Liu Y, Yang P, Shi J, Zhuang S, Forman MR, Wu S, Gao X. In utero exposure to the Great Chinese Famine and risk of intracerebral hemorrhage in midlife. Neurology 2020; 94:e1996-e2004. [PMID: 32277057 DOI: 10.1212/wnl.0000000000009407] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To investigate whether in utero exposure to the Great Chinese Famine in 1959 to 1961 was associated with risk of intracerebral hemorrhage (ICH) in adulthood. METHODS In this cohort analysis, we included 97,399 participants of the Kailuan Study who were free of cardiovascular disease and cancer at baseline (2006). Cases of incident ICH were confirmed by medical record review. We used the Cox proportional hazards model to calculate the hazard ratio (HR) and 95% confidence interval (CI) for ICH according to in utero famine exposure status. RESULTS Among 97,399 participants in the current analyses, 6.3% (n = 6,160) had been prenatally exposed to the Great Chinese Famine. During a median 9.0 years of follow-up (2006-2015), we identified 724 cases of incident ICH. After adjustment for potential confounders, the HR of ICH was 1.99 (95% CI 1.39-2.85) for in utero famine-exposed individuals vs individuals who were not exposed to the famine. When exposure to famine and severity of famine were examined jointly, the adjusted HR was 2.99 (95% CI 1.21-7.39) for in utero exposure to severe famine and 1.94 (95% CI 1.32-2.84) for in utero exposure to less severe famine relative to those without exposure to famine. CONCLUSIONS Individuals with in utero exposure to famine, especially those exposed to severe famine, were more likely to have ICH in midlife, highlighting the role of nutritional factors in susceptibility to this severe cerebral condition.
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Affiliation(s)
- Yun Li
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Yanping Li
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - M Edip Gurol
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Yesong Liu
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Peng Yang
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Jihong Shi
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Sheng Zhuang
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Michele R Forman
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN
| | - Shouling Wu
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN.
| | - Xiang Gao
- From the Department of Preventive Medicine (Yun Li), School of Public Health, North China University of Science and Technology, Tangshan; Department of Nutritional Sciences (Yun Li, X.G.), Pennsylvania State University, State College; Department of Nutrition (Yanping Li), Harvard T.H. Chan School of Public Health; Department of Neurology (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Neurology (Y. Liu) and Cardiology (J.S., S.W.), Kailuan General Hospital, North China University of Science and Technology; Department of Neurosurgery (P.Y.), Affiliated Hospital of North China University of Science and Technology, Tangshan; Department of Neurology (S.Z.), The Second Affiliated Hospital of Soochow University, Suzhou, China; and Department of Nutrition Science (M.R.F.), Purdue University, West Lafayette, IN.
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Nobles J, Hamoudi A. Detecting the Effects of Early-Life Exposures: Why Fecundity Matters. POPULATION RESEARCH AND POLICY REVIEW 2019; 38:783-809. [PMID: 33408430 PMCID: PMC7785096 DOI: 10.1007/s11113-019-09562-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/29/2019] [Indexed: 12/28/2022]
Abstract
Prenatal exposures have meaningful effects on health across the lifecourse. Innovations in causal inference have shed new light on these effects. Here, we motivate the importance of innovation in the characterization of fecundity, and prenatal selection in particular. We argue that such innovation is crucial for expanding knowledge of the fetal origins of later life health. Pregnancy loss is common, responsive to environmental factors, and closely related to maternal and fetal health outcomes. As a result, selection into live birth is driven by many of the same exposures that shape the health trajectories of survivors. Lifecourse effects that are inferred without accounting for these dynamics may be significantly distorted by survival bias. We use a set of Monte Carlo simulations with realistic parameters to examine the implications of prenatal survival bias. We find that even in conservatively specified scenarios, true fetal origin effects can be underestimated by 50% or more. In contrast, effects of exposures that reduce the probability of prenatal survival but improve the health of survivors will be overestimated. The absolute magnitude of survival bias can even exceed small effect sizes, resulting in inferences that beneficial exposures are harmful or vice-versa. We also find reason for concern that moderately sized true effects, underestimated due to failure to account for selective survival, are missing from scientific knowledge because they do not clear statistical significance filters. This bias has potential real-world costs; policy decisions about interventions to improve maternal and infant health will be affected by underestimated program impact.
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Affiliation(s)
- Jenna Nobles
- University of Wisconsin, Madison, 1180 Observatory Drive Madison, Wisconsin 53706
| | - Amar Hamoudi
- University of Wisconsin, Madison, 1180 Observatory Drive Madison, Wisconsin 53706
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Reported patterns of pregnancy termination from Demographic and Health Surveys. PLoS One 2019; 14:e0221178. [PMID: 31425531 PMCID: PMC6699730 DOI: 10.1371/journal.pone.0221178] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/31/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Demographic and Health Surveys, widely used for estimation of fertility and reproductive health indicators in developing countries, remain underutilized for the study of pregnancy termination. This is partly due to most surveys not reporting the type of pregnancy termination, whether spontaneous or induced. Reproductive calendar data makes it possible to examine termination patterns according to contraceptive use at the time of pregnancy. Contraceptive failure is expected to increase the likelihood of induced abortion helping in the interpretation of reported termination patterns. MATERIALS AND METHODS We use individual-level calendar data regarding 623,966 pregnancies to analyze levels and differentials in reported patterns of pregnancy termination by age, union status, and contraceptive use in 107 DHS surveys from 50 countries. From the estimates of the probability of pregnancy termination, we compute derived reproductive health indicators providing an assessment of what is driving the differences by comparison to the few surveys reporting the type of pregnancy termination. RESULTS From our estimates, 10.9% of pregnancies do not end in live-birth and 63.7% of them are spontaneous terminations. Reported pregnancy termination is higher among women using contraceptives, consistent with expectations. Very low levels of reported PT in some countries, particularly in sub-Saharan Africa, suggests possible underreporting. Differential patterns emerging from cluster analysis and regional rates indicate high rates of pregnancy termination driven by induced abortion in countries from the Former Soviet Union and Asian countries with liberal laws. Most countries with restrictive abortion laws have low levels of reported termination. While the probabilities of pregnancy termination are higher at older ages, termination rates generally peak at younger ages due to higher conception rates. DISCUSSION This is the first large comparative study of the patterns of reported pregnancy termination in DHS surveys. While we have explored the extent to which differences arise from spontaneous terminations or induced abortion, more research is needed regarding the determinants of reported pregnancy termination.
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Tao T, Dai L, Ma J, Li Y, Guo Z. Association between early-life exposure to the Great Chinese Famine and poor physical function later in life: a cross-sectional study. BMJ Open 2019; 9:e027450. [PMID: 31326928 PMCID: PMC6661887 DOI: 10.1136/bmjopen-2018-027450] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between early-life exposure to the Great Chinese Famine (1959-1961) and the prevalence of poor physical function in midlife. DESIGN A population-based historical prospective study was performed as part of a wider cross-sectional survey. Exposure to famine was defined by birthdate, and participants were divided into non-exposed group, fetal-exposed group and infant-exposed group. SETTING AND PARTICIPANTS A total of 3595 subjects were enrolled into the study from the China Health and Retirement Longitudinal Study (CHARLS) 2015 based on random selection of households that had at least one member aged 45 years old and older in 28 provinces of mainland China. MAIN OUTCOME MEASURES Physical function status was assessed by a six-item self-report on the Barthel scale which rated basic activities of daily living (BADL). RESULTS 743 (20.7%) out of all participants were exposed to the Great Chinese Famine in their fetal periods, while 1550 (43.1%) participants were exposed at the age of an infant. The prevalence of poor physical function in the non-exposed group, fetal period-exposed group and infant period-exposed group were 12.3%, 15.5% and 17.0%, respectively. Among males, after stratification by gender and severity of famine, the prevalence of poor physical function in the fetal period was significantly higher (OR 2.40, 95% CI 1.18 to 4.89, p=0.015) than the non-exposed group in severely affected areas, even after adjusting for the number of chronic diseases, place of residence, smoking and alcohol drinking habits, marital status, educational level and body mass index. A similar connection between prenatal and early postnatal exposure to the Great Chinese Famine and the prevalence of poor physical function in midlife, however, was not observed from female adults. CONCLUSIONS Males who were exposed to the Great Chinese Famine (1959-1961) present considerably decreased physical function in their later life.
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Affiliation(s)
- Tao Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Lingyan Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - JinXiang Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yusi Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Zhuoyuan Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Guangzhou Medical University, Guangzhou, China
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Kant C. Stillbirths: how should its rate be reported, its disability-adjusted-life-years (DALY), and stillbirths adjusted life expectancy. BMC Med Inform Decis Mak 2019; 19:133. [PMID: 31307445 PMCID: PMC6631739 DOI: 10.1186/s12911-019-0850-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A 2016 study standardized the definition of stillbirths. It estimated the rate as a proportion of total births. A 2015 paper addressed the problem of disability-adjusted life-years (DALY) for stillbirths. There has been no adjustment of life expectancy at birth to account for stillbirths. METHODS AND RESULTS We follow mathematical and computational methods, use algebra to derive relationships, and large databases. We express the rate as a proportion of live births and use this rate to adjust life expectancy at birth for stillbirths. We then use the difference between the traditional life expectancy and stillbirths adjusted life expectancy (SALE) to obtain DALY for stillbirths for 194 countries, the Millennium Development Goal regions, and income groups. We show defining stillbirths' rate as a proportion of live births enhances stillbirths' importance, especially in poorer countries; negates some of its under-statement vis-a-vis neonatal mortality rate, accentuates its decrease; and permits inference about relative magnitudes of stillbirths and neonatal mortality from the two rates. Using it, we derive stillbirths adjusted life expectancy, and suggest it reflects a more complete and accurate measure of comparative life expectancies of different countries. Its difference from the traditional life expectancy is used to measure DALY for stillbirths that totals 165.3 million years worldwide. CONCLUSION Stillbirths almost equals neonatal mortality yet have not received almost equal attention. We hope highlighting them and adjusting life expectancy for it will spur health interventions so that grand convergence of health outcomes in different countries can be more rapidly achieved. We also believe SALE is a more complete and accurate measure of comparative life expectancies.
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Affiliation(s)
- Chander Kant
- Department of Economics, Seton Hall University, 400 South Orange Avenue, South Orange, NJ, 07078, USA.
- Principal, Kant Research, 1 Fielding Road, Short Hills, NJ, 07078, USA.
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Early-Life Exposure to the Chinese Famine Is Associated with Higher Methylation Level in the INSR Gene in Later Adulthood. Sci Rep 2019; 9:3354. [PMID: 30833584 PMCID: PMC6399294 DOI: 10.1038/s41598-019-38596-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/04/2019] [Indexed: 12/19/2022] Open
Abstract
We examined the association between the China famine exposure in early life and DNA methylation of INSR (hg18, chr19:7110130-7110574) and CPT1A (hg18, chr11: 68286513-68286952) related to growth and metabolism in 235 subjects selected from two provinces in China. The subjects were categorized into prenatal famine-exposed group and non-exposed group based on their birthdates. DNA methylation at the INSR gene locus was assayed from peripheral white blood cells using the Sequenom's MassARRAY system. Two dependent samples t-test was used to compare the difference between the exposed group and non-exposed group. DNA methylation level of INSR was higher among individuals who exposed to the China famine in the fetus than that of non-exposed group (d = 3.3%, P = 0.006). A significant interaction between famine exposure and province was observed for INSR (Pinteraction < 0.001). DNA methylation level of INSR was positively associated with triglyceride (β = 0.011, P = 0.021), and negatively associated with high-density lipoprotein cholesterol (β = -0.039, P = 0.021). Moreover, exposed group had higher meat consumption than non-exposed group in severe exposure area. Prenatal exposure to the China famine plus later life eating habits might regulate epigenome.
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Wang Z, Zou Z, Yang Z, Dong Y, Song J, Dong B, Ma J, Arnold L. The association between fetal-stage exposure to the China famine and risk of diabetes mellitus in adulthood: results from the China health and retirement longitudinal study. BMC Public Health 2018; 18:1205. [PMID: 30367620 PMCID: PMC6204016 DOI: 10.1186/s12889-018-6134-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The associations of famine exposure with diabetes risk in adulthood are still unclear. This study aimed to explore the association between famine exposure in early life and risk of diabetes in adulthood. METHODS A total of 4138 subjects were selected from the data of the China Health and Retirement Longitudinal Study (CHARLS) 2011-2012. Diabetes was diagnosed as fasting plasma glucose (FPG) ≥7.0 mmol/L, glycated haemoglobin (HbA1C) > 6.5%, or self-reported diabetes. Birthdates of subjects were used to categorize famine exposure groups. The association of fetal-stage famine exposure with diabetes risk in adults was assessed using logistics regression model. RESULTS The prevalence of diabetes in the non-exposed, fetal-stage exposed, infant-stage exposed, and preschool-stage exposed groups were 9.0, 13.6, 12.7 and 10.8%, respectively. Compared with the age-balanced control group, the fetal-stage exposed group was associated with the elevated risk of diabetes in later life after adjusting for covariates (OR = 1.37; 95%CI: 1.09-1.72; P = 0.008). Stratified analysis showed that the association between prenatal famine exposure and diabetes risk in adulthood was comparable between severely affected areas and less severely affected areas (P for interaction =0.153). CONCLUSIONS Famine exposure in fetal stages was associated with the elevated diabetes risk in adults, which could be the critical periods for relative intervention.
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Affiliation(s)
- Zhenghe Wang
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zhiyong Zou
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zhongping Yang
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yanhui Dong
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Jieyun Song
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Bin Dong
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
| | - Jun Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
| | - Luke Arnold
- Population Health & South Western Sydney Primary Health Network, Sydney, NSW, Australia
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Bruckner TA, Catalano R. Selection in utero and population health: Theory and typology of research. SSM Popul Health 2018; 5:101-113. [PMID: 29928686 PMCID: PMC6008283 DOI: 10.1016/j.ssmph.2018.05.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 01/05/2023] Open
Abstract
Public health researchers may assume, based on the fetal origins literature, that "scarring" of birth cohorts describes the population response to modern-day stressors. We contend, based on extensive literature concerned with selection in utero, that this assumption remains questionable. At least a third and likely many more of human conceptions fail to yield a live birth. Those that survive to birth, moreover, do not represent their conception cohort. Increasing data availability has led to an improved understanding of selection in utero and its implications for population health. The literature describing selection in utero, however, receives relatively little attention from social scientists. We aim to draw attention to the rich theoretical and empirical literature on selection in utero by offering a typology that organizes this diverse work along dimensions we think important, if not familiar, to those studying population health. We further use the typology to identify important gaps in the literature. This work should interest social scientists for two reasons. First, phenomena of broad scholarly interest (i.e., social connectivity, bereavement) affect the extent and timing of selection in utero. Second, the life-course health of a cohort depends in part on the strength of such selection. We conclude by identifying new research directions and with a reconciliation of the apparent contradiction between the "fetal origins" literature and that describing selection in utero.
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Affiliation(s)
- Tim A. Bruckner
- Program in Public Health, University of California, Irvine, 653 E. Peltason Dr. Suite 2046, 2nd Floor, Irvine, CA 92697-3957, USA
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, 15 University Hall, Berkeley, CA 94720, USA
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Chinese famine exposure in infancy and metabolic syndrome in adulthood: results from the China health and retirement longitudinal study. Eur J Clin Nutr 2018; 73:724-732. [PMID: 29844493 DOI: 10.1038/s41430-018-0211-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES To explore the association between famine exposure in early life and the risk of metabolic syndrome in the Chinese adults. SUBJECTS/METHODS A total of 2148 participants aged 50s were selected from a large national epidemiological survey in the China. The logistic regression models were used to analyze the association between famine exposure in early life and risk of metabolic syndrome in adulthood. RESULTS The prevalence of metabolic syndrome among individuals in the preschool exposed group, infant exposed group, fetal exposed group, and the non-exposed group was 37.9, 43.5, 37.5, and 34.0%, respectively. The prevalence of metabolic syndrome in the infant exposed group was significantly higher than the non-exposed group (43.5 vs. 34.0%, P = 0.006). Compared with the non-exposed group, individuals who exposed to the famine in infancy significantly increased the risk of metabolic syndrome (OR = 1.83; 95% CI: 1.24, 2.70) after adjusting for gender, smoking status, drinking status, physical activity, and the educational levels of participants and their parents. However, similar results were not observed in the fetal (OR = 1.25; 95% CI: 0.89, 1.74) or the preschool (OR = 1.30; 95% CI: 0.97, 1.75) exposed groups. CONCLUSIONS The Great China famine exposure during infancy was linked with the elevated risk of metabolic syndrome in adults aged 50s, which provided further evidence for the developmental origins hypothesis.
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Wang Z, Zou Z, Dong B, Ma J, Arnold L. Association between the Great China Famine exposure in early life and risk of arthritis in adulthood. J Epidemiol Community Health 2018; 72:790-795. [PMID: 29680802 DOI: 10.1136/jech-2017-210334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/05/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND The association between famine exposure in early life and risk of arthritis (combination of osteoarthritis and inflammatory arthritis) in adulthood is unclear. The aim of this study is to explore the association. METHODS A total of 4124 subjects were selected from the national data of the China Health and Retirement Longitudinal Study in 2011-2012. Doctor-diagnosed arthritis was self-reported in participants' questionnaire. Birthdates were used to categorise participants into famine-exposed and non-exposed groups. Logistic regression model was used to explore the association of famine exposure in early life with the risk of arthritis in adulthood. RESULTS The prevalence of arthritis in both infant-exposed and preschool-exposed groups was significantly higher than those in the non-exposed group (35.0% and 30.6% vs 27.3%; p<0.05). Compared with the non-exposed group, the infant-exposed group showed a significantly elevated risk of arthritis in adulthood after adjusting for confounding factors (OR=1.65; 95% CI 1.29 to 2.11; p<0.001). In the stratified analysis, we found that participants who lived in severely affected areas (OR=1.91; 95% CI 1.41 to 2.59; p<0.001), who are female (OR=2.21; 95% CI 1.57 to 3.11; p<0.001) and those with a body mass index ≥24.0 kg/m2 (OR=2.46; 95% CI 1.70 to 3.55; p<0.001) in the infant-exposed group had increased risk of arthritis in adulthood. Similar results were additionally observed when age-balanced control group was used. CONCLUSION Great China Famine exposure in infancy may be associated with an elevated risk of arthritis in adulthood, particularly in women and participants with adiposity. These findings suggest nutrition intervention in infancy and weight control in later life may reduce the risk of arthritis in adulthood.
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Affiliation(s)
- Zhenghe Wang
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Zhiyong Zou
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Bin Dong
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Jun Ma
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Luke Arnold
- Population Health, South Western Sydney Primary Health Network, Sydney, New South Wales, Australia
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Zheng X, Ren W, Gong L, Long J, Luo R, Wang Y. The Great Chinese Famine Exposure in Early Life and the Risk of Nonalcoholic Fatty Liver Disease in Adult Women. Ann Hepatol 2017; 16:901-908. [PMID: 29055916 DOI: 10.5604/01.3001.0010.5281] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Previous studies found famine exposure was associated with a higher risk of metabolic syndrome (MetS). In the study, we investigated the relationship between Chinese famine exposure and the risk of nonalcoholic fatty liver disease (NAFLD) in adult women. MATERIALS AND METHODS Data were obtained from subjects via routine physical examinations in the Public Health Center of our hospital between 2011 and 2014. Women were categorized into the following three groups: control, prenatally exposed, and postnatally exposed. Hepatic steatosis was diagnosed according to the guidelines established for the diagnosis and treatment of NAFLD. RESULTS The prevalence rates of NAFLD among non-exposed, prenatally, and postnatally exposed women were 17.3, 23.0, and 22.9%, respectively. Pre-exposed and postnatally exposed women had higher risks of NAFLD, exhibiting ORs (95% CI) of 1.33 (1.04-1.70) and 1.26 (1.03-1.55), respectively. Prenatally, but not postnatally, exposed women had significantly higher risks of having abnormal alanine aminotransferase (ALT), with ORs of 1.30 (1.05-1.61). CONCLUSIONS The results indicate a significant association between famine exposure in early life and the risk of NAFLD in adult women. Prenatally exposed women displayed higher risks of NAFLD and mild, moderate and severe steatosis.
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Affiliation(s)
- Xiaoya Zheng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Ren
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lilin Gong
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Long
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Luo
- The Public Health Center, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yonghong Wang
- The Public Health Center, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang Z, Li C, Yang Z, Ma J, Zou Z. Fetal and infant exposure to severe Chinese famine increases the risk of adult dyslipidemia: Results from the China health and retirement longitudinal study. BMC Public Health 2017; 17:488. [PMID: 28610568 PMCID: PMC5470181 DOI: 10.1186/s12889-017-4421-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/14/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To explore the associations between the Chinese famine exposure in early life and the dyslipidemia in adulthood. METHODS We selected 2752 participants from the baseline survey of China Health and Retirement Longitudinal Study (CHARLS) 2011-2012 to evaluate the associations of early life the Chinese famine exposure with risk of dyslipidemia in adulthood. Dyslipidemia was defined as TC (Total Cholesterol): HDL-C (High-Density Lipoprotein Cholesterol) ratio ≥ 5.0 or use cholesterol lowering drugs. Famine exposure cohorts were categorized by birthdates of participants. Binary logistics regression model was used to examine the associations of early-life famine exposure with the risk of dyslipidemia. RESULTS The dyslipidemia prevalence of the non-exposed cohort, fetal stage-, infant stage-, and preschool stage-exposed cohorts in adulthood was 15.7%, 23.1%, 22.0%, and 18.6%, respectively. Early-life exposure to the Chinese famine significantly increased LDL cholesterol concentrations in adulthood after adjusted for age. The risks of dyslipidemia in fetal (OR = 1.58; 95% CI: 1.23-2.03; P < 0.001) and infant (OR = 1.52; 95% CI: 1.15-2.00; P = 0.003) stage-exposed cohorts were significantly higher than the non-exposed cohort after adjusted for gender and current family economic status. Following gender stratification, we found that fetal (OR = 1.80; 95% CI: 1.26-2.57; P = 0.001), infant (OR = 1.75; 95% CI: 1.17-2.62; P = 0.006), and preschool (OR = 1.63; 95% CI: 1.10-2.42; P = 0.015) -stage exposure to severe famine aggravated the risk of dyslipidemia in female adults. However, the similar association was not observed for male adults. CONCLUSIONS Early-life exposure to severe Chinese famine could link with the higher dyslipidemia risk in female adulthood, but not in male adulthood. This gender-specific effect might be associated with the hypothesis that parents in China prefer boys to girls traditionally or survivors' bias.
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Affiliation(s)
- Zhenghe Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Zhongping Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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Wang Z, Zou Z, Yang Z, Dong Y, Ma J. Association between exposure to the Chinese famine during infancy and the risk of self-reported chronic lung diseases in adulthood: a cross-sectional study. BMJ Open 2017; 7:e015476. [PMID: 28576899 PMCID: PMC5623412 DOI: 10.1136/bmjopen-2016-015476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the association between early-life exposure to the Chinese famine and the risk of chronic lung diseases in adulthood. DESIGN Data analysis from a cross-sectional survey. SETTING AND PARTICIPANTS 4135 subjects were enrolled into the study from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2012 baseline survey to analyse the associations between prenatal and early postnatal famine exposure and the risk of chronic lung diseases in adulthood. MAIN OUTCOME MEASURES Chronic lung diseases were defined based on self-reported information. RESULTS The prevalence of self-reported chronic lung diseases in fetus-exposed, infant-exposed, preschool-exposed, and non-exposed groups was 6.5%, 7.9%, 6.8%, and 6.1%, respectively. The risk of chronic lung diseases in the infant-exposed group was significantly higher (OR 1.95, 95% CI 1.10 to 3.44) than the non-exposed group in severely affected areas, even after adjusting for gender, smoking, and drinking, family economic status, and the highest educational attainment of the parents (OR 2.57, 95% CI 1.26 to 5.25). In addition, after stratification by gender and famine severity, we found that only infant exposure to the severe famine was associated with the elevated risk of chronic lung diseases among male adults (OR 3.16, 95% CI 1.17 to 8.51). CONCLUSIONS Severe famine exposure during the period of infancy might increase the risk of chronic lung diseases in male adults.
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Affiliation(s)
- Zhenghe Wang
- School of Public Health, Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Zhiyong Zou
- School of Public Health, Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Zhongping Yang
- School of Public Health, Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Yanhui Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Jun Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
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Zhang Z, Song S, Wu X. Exodus from Hunger: The Long-Term Health Consequences of the 1959-1961 Chinese Famine. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2017; 63:148-166. [PMID: 28521622 DOI: 10.1080/19485565.2017.1311203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article examines the long-term health consequences of China's 1959-1961 famine by comparing people who stayed in Guangdong and endured the famine with people who crossed the border to immigrate to Hong Kong and thus escaped the famine. Based on data from the Hong Kong Panel Study of Social Dynamics (HKPSSD) and the China Family Panel Studies (CFPS), we focused on two health indicators-body mass index (BMI) and self-rated health (SRH)-of the cohort born before 1959. Our results show that the stayers who experienced the famine have a lower BMI than the emigrants, and they are likely to have a poor SRH. The difference-in-differences (DID) estimates further show that the famine exposure reduced the odds of giving higher ratings of SRH by 60 and 42 percent, respectively, for the 1923-1940 and 1941-1958 birth cohorts. For the 1923-1940 cohort, famine exposure also reduced their BMI by 1.5 points.
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Affiliation(s)
- Zhuoni Zhang
- a Department of Applied Social Sciences , City University of Hong Kong , Kowloon , Hong Kong
| | - Shige Song
- b Department of Sociology , Queens College, CUNY , Queens , New York , USA
| | - Xiaogang Wu
- c Division of Social Science , The Hong Kong University of Science and Technology , Kowloon , Hong Kong
- d School of Sociology and Political Science , Shanghai University , China
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Bruckner TA, Mortensen LH, Catalano RA. Spontaneous Pregnancy Loss in Denmark Following Economic Downturns. Am J Epidemiol 2016; 183:701-8. [PMID: 27009344 DOI: 10.1093/aje/kww003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/27/2015] [Indexed: 11/13/2022] Open
Abstract
An estimated 11%-20% of clinically recognized pregnancies result in spontaneous abortion. The literature finds elevated risk of spontaneous abortion among women who report adverse financial life events. This work suggests that, at the population level, national economic decline-an ambient and plausibly unexpected stressor-will precede an increase in spontaneous abortion. We tested this hypothesis using high-quality information on pregnancy and spontaneous loss for all women in Denmark. We applied time-series methods to monthly counts of clinically detected spontaneous abortions (n = 157,449) and the unemployment rate in Denmark beginning in January 1995 and ending in December 2009. Our statistical methods controlled for temporal patterns in spontaneous abortion (e.g., seasonality, trend) and changes in the population of pregnancies at risk of loss. Unexpected increases in the unemployment rate preceded by 1 month a rise in the number of spontaneous abortions (β = 33.19 losses/month, 95% confidence interval: 8.71, 57.67). An attendant analysis that used consumption of durable household goods as an indicator of financial insecurity supported the inference from our main test. Changes over time in elective abortions and in the cohort composition of high-risk pregnancies did not account for results. It appears that in Denmark, ambient stressors as common as increasing unemployment may precede a population-level increase in spontaneous abortion.
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30
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Valente C. Civil conflict, gender-specific fetal loss, and selection: a new test of the Trivers-Willard hypothesis. JOURNAL OF HEALTH ECONOMICS 2015; 39:31-50. [PMID: 25461897 DOI: 10.1016/j.jhealeco.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 06/04/2023]
Abstract
A sizeable economics literature explores the effect of prenatal shocks on later health or socioeconomic status. Work in other disciplines, following the seminal contribution of Trivers and Willard (1973), suggests that prenatal shocks may increase fetal loss and reduce the number of boys relative to girls at birth. This has been largely ignored in the economics literature and could affect the interpretation of estimates of the effect of prenatal shocks and that of gender in other applied economics contexts. This paper analyzes the effect of in utero exposure to a shock - civil conflict in Nepal - on (i) fetal loss, and (ii) gender and (iii) health at birth. Maternal fixed effects estimates show that exposed pregnancies are more likely to result in a miscarriage and in a female birth, but exposed newborns are neither smaller nor more subject to neonatal mortality.
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Fan W, Qian Y. Long-term health and socioeconomic consequences of early-life exposure to the 1959-1961 Chinese Famine. SOCIAL SCIENCE RESEARCH 2015; 49:53-69. [PMID: 25432603 DOI: 10.1016/j.ssresearch.2014.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 06/06/2014] [Accepted: 07/17/2014] [Indexed: 06/04/2023]
Abstract
This research investigates long-term consequences of early-life malnutrition by examining effects of the 1959-1961 Chinese Famine. Taking into account temporal and geographic variations in famine severity, we construct a difference-in-differences estimator to identify effects of early-life exposure to famine on perceived health and socioeconomic outcomes in midlife. Using a sample of 1716 adults born in 1955-1966 in rural China from a nationally representative survey-the 2005 Chinese General Social Survey-we find that the famine had adverse effects on mid-life health for males born into families where at least one parent was a Communist Party member and females regardless of parental party membership. Being born during the famine had no effects on years of education or income for either gender. Quantile regressions suggest intense mortality selection among males who had no party-affiliated parents. Our study highlights the importance of timing and contexts of life experiences in shaping health.
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Affiliation(s)
- Wen Fan
- Department of Sociology, University of Minnesota, United States.
| | - Yue Qian
- Department of Sociology, Ohio State University, United States
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32
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Huang C, Guo C, Nichols C, Chen S, Martorell R. Elevated levels of protein in urine in adulthood after exposure to the Chinese famine of 1959-61 during gestation and the early postnatal period. Int J Epidemiol 2014; 43:1806-14. [PMID: 25298393 DOI: 10.1093/ije/dyu193] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Animal models have suggested that undernutrition during gestation and the early postnatal period may adversely affect kidney development and compromise renal function. As a natural experiment, famines provide an opportunity to test such potential effects in humans. We assessed whether exposure to the Chinese famine of 1959-1961 during gestation and early postnatal life was associated with the levels of proteinuria among female adults three decades after exposure to the famine. METHODS We measured famine intensity using the cohort size shrinkage index and we constructed a difference-in-difference model to compare the levels of proteinuria, measured with a dipstick test of random urine specimens, among Chinese women (n = 70 543) whose exposure status to the famine varied across birth cohorts (born before, during or after the famine) and counties of residence with different degrees of famine intensity. RESULTS Famine exposure was associated with a greater risk [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.04, 2.28; P = 0.029) of having higher level of proteinuria among women born during the famine years (1959-61) compared with the unexposed post famine-born cohort (1964-65) in rural samples. No association was observed among urban samples. Results were robust to adjustment for covariates. CONCLUSIONS Severe undernutrition during gestation and the early postnatal period may have long-term effects on levels of proteinuria in humans, but the effect sizes may be small.
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Affiliation(s)
- Cheng Huang
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Chaoran Guo
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Catherine Nichols
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Shuo Chen
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
| | - Reynaldo Martorell
- George Washington University - Department of Global Health, Washington, District of Columbia, United States, UC Berkeley School of Public Health - Health Services & Policy Analysis, Berkeley, California, United States, University of Maryland School of Public Health, College Park, Maryland, United States and Emory University - Hubert Department of Global Health, Atlanta, Georgia, United States
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Song S. Malnutrition, Sex Ratio, and Selection. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2014; 25:580-95. [DOI: 10.1007/s12110-014-9208-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lewington S, Li L, Murugasen S, Hong LS, Yang L, Guo Y, Bian Z, Collins R, Chen J, He H, Wu M, He T, Ren X, Meng J, Peto R, Chen Z. Temporal trends of main reproductive characteristics in ten urban and rural regions of China: the China Kadoorie biobank study of 300 000 women. Int J Epidemiol 2014; 43:1252-62. [PMID: 24639443 PMCID: PMC4121552 DOI: 10.1093/ije/dyu035] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chinese women's reproductive patterns have changed significantly over the past several decades. However, relatively little is known about the pace and characteristics of these changes either overall or by region and socioeconomic status. METHODS We examined the cross-sectional data from the China Kadoorie Biobank cohort study that recruited 300 000 women born between 1930 and 1974 (mean age: 51 years) from 10 socially diverse urban and rural regions of China. Temporal trends in several self-reported reproductive characteristics, and effect modification of these trends by area and education (as a surrogate for socioeconomic status), were examined. RESULTS The overall mean age at menarche was 15.4 (standard deviation 1.9) years, but decreased steadily over the 45 birth cohorts from 16.1 to 14.3 years, except for an anomalous increase of ∼1 year for women exposed to the 1958-61 famine in early adolescence. Similarly large changes were seen for other characteristics: mean parity fell (urban: 4.9 to 1.1; rural: 5.9 to 1.4); mean age at first birth increased (urban: 19.0 to 25.9 years; rural: 18.3 to 23.8 years); and birth spacing increased after 1980 to over 5 years. Breastfeeding declined after 1950 in urban and, after 1980, in rural women; and 68% of urban and 48% of rural women experienced a terminated pregnancy. Mean age at menopause increased from 47.9 to 49.3 years. CONCLUSIONS There have been striking changes in reproductive factors over time and between areas among these Chinese women. Their effects on major chronic diseases should be investigated.
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Affiliation(s)
- Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - LiMing Li
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, ChinaClinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Serini Murugasen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Lai-san Hong
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Yu Guo
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Zheng Bian
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Junshi Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Hui He
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Ming Wu
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Tianyou He
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Xiaolan Ren
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Jinhuai Meng
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK, School of Public Health, Peking University Health Science Center, Beijing, China, Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China, Chinese National Center for Food Safety Risk Assessment, Beijing, China, Nangang Center for Disease Control, Haerbin, Heilongjiang, China, Jiangsu Centre for Disease Control, Nanjing, Jiangsu, China, Huixian Centre for Disease Control, Huixian, Hennan, China, Gansu Centre for Disease Control, Lanzhou, Gansu, China and Liuzhou Centre for Disease Control, Liuzhou, Guangxi, China
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Speakman JR. Evolutionary perspectives on the obesity epidemic: adaptive, maladaptive, and neutral viewpoints. Annu Rev Nutr 2014; 33:289-317. [PMID: 23862645 DOI: 10.1146/annurev-nutr-071811-150711] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The prevalence of obesity in modern societies has two major contributory factors-an environmental change that has happened in historical times and a genetic predisposition that has its origins in our evolutionary history. Understanding both aspects is complex. From an evolutionary perspective, three different types of explanation have been proposed. The first is that obesity was once adaptive and enabled us to survive (or sustain fecundity) through periods of famine. People carrying so-called thrifty genes that enabled the efficient storage of energy as fat between famines would be at a selective advantage. In the modern world, however, people who have inherited these genes deposit fat in preparation for a famine that never comes, and the result is widespread obesity. The key problem with this, and any other adaptive scenario, is to understand why, if obesity was historically so advantageous, many people did not inherit these thrifty genes and in modern society are able to remain slim, despite the environmental change favoring fat storage. The second type of explanation is that obesity is not adaptive and may never even have existed in our evolutionary past, but it is favored today as a maladaptive by-product of positive selection on some other trait. An example of this type of explanation is the suggestion that obesity results from variation in brown adipose tissue thermogenesis. Finally, a third class of explanation is that most mutations in the genes that predispose us to obesity are neutral and have been drifting over evolutionary time--so-called drifty genes, leading some individuals to be obesity prone and others obesity resistant. In this article, I review the current evidence for and against these three different scenarios and conclude that the thrifty gene hypothesis is untenable but the other two ideas may provide a cogent explanation of the modern obesity phenomenon.
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Affiliation(s)
- John R Speakman
- Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, Beijing 100101, People's Republic of China.
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Huang C, Phillips MR, Zhang Y, Zhang J, Shi Q, Song Z, Ding Z, Pang S, Martorell R. Malnutrition in early life and adult mental health: evidence from a natural experiment. Soc Sci Med 2013; 97:259-66. [PMID: 23313495 PMCID: PMC3726543 DOI: 10.1016/j.socscimed.2012.09.051] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 07/21/2012] [Accepted: 09/19/2012] [Indexed: 01/03/2023]
Abstract
As natural experiments, famines provide a unique opportunity to test the health consequences of nutritional deprivation during the critical period of early life. Using data on 4972 Chinese born between 1956 and 1963 who participated in a large mental health epidemiology survey conducted between 2001 and 2005, we investigated the potential impact of exposure to the 1959-1961 Chinese Famine in utero and during the early postnatal life on adult mental illness. The risk of mental illness was assessed with the 12-item General Health Questionnaire (GHQ-12) and eight other risk factors, and the famine impact on adult mental illness was estimated by difference-in-difference models. Results show that compared with unexposed women born in 1963, women born during the famine years (1959-1961) had higher GHQ scores (increased by 0.95 points; CI: 0.26, 1.65) and increased risk of mental illness (OR = 2.80; CI: 1.23, 6.39); those born in 1959 were the most affected and had GHQ scores 1.52 points higher (CI: 0.42, 2.63) and an OR for mental illness of 4.99 (CI: 1.68, 14.84). Compared to men in the 1963 birth cohort, men born during the famine had lower GHQ scores (decreased by 0.89 points; CI: -1.59, -0.20) and a nonsignificant decrease in the risk of mental illness (OR = 0.60; CI: 0.26, 1.40). We speculate that the long-term consequences of early-life famine exposure include both the selection of the hardiest and the enduring deleterious effects of famine on those who survive. The greater biological vulnerability and stronger natural selection in utero of male versus female fetuses during severe famine may result in a stronger selection effect among men than women, obscuring the deleterious impact of famine exposure on the risk of mental illness in men later in life.
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Affiliation(s)
- Cheng Huang
- Department of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC, USA.
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Song S. Assessing the impact of in utero exposure to famine on fecundity: Evidence from the 1959–61 famine in China. Population Studies 2013; 67:293-308. [DOI: 10.1080/00324728.2013.774045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Shige Song
- Queens College of The City University of New York
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SEX- AND AGE-RELATED MORTALITY PROFILES DURING FAMINE: TESTING THE ‘BODY FAT’ HYPOTHESIS. J Biosoc Sci 2013; 45:823-40. [DOI: 10.1017/s0021932012000818] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SummaryDuring famines females generally have a mortality advantage relative to males, and the highest levels of mortality occur in the very young and the elderly. One popular hypothesis is that the sex differential in mortality may reflect the greater body fatness combined with lower metabolism of females, which may also underpin the age-related patterns of mortality among adults. This study evaluated the ‘body fat’ hypothesis using a previously published and validated mathematical model of survival during total starvation. The model shows that at a given body weight females would indeed be expected to survive considerably longer than males in the absence of food. At a mass of 70 kg for example a female aged 30 would survive for 144 days compared with life expectancy of only 95 days for a male of the same age and weight. This effect is contributed to by both the higher body fatness and lower metabolism of the females at a given body weight. However, females are generally smaller than males and in addition to a sex effect there was also a major effect of body size – heavier individuals survive longer. When this body size effect was removed by considering survival in relation to BMI the sex effect was much reduced, and could be offset by a relatively small difference in pre-famine BMI between the sexes. Nevertheless, combining these predictions with observed mean BMIs of males and females across 48 countries at the low end of the obesity spectrum suggests that in the complete absence of food females would survive on average about 40% longer (range 6 to 64.5%) than males. The energy balance model also predicted that older adult individuals should survive much longer than younger adult individuals, by virtue of their lower resting metabolic rates and lower activity levels. Observations of the female survival advantage in multiple famines span a much wider range than the model prediction (5% to 210%). This suggests in some famines body fatness may be a significant factor influencing the mortality differential between the sexes, but in other famines other factors are likely to be more important. Moreover, the pattern of mortality in relation to age is completely opposite that predicted. These data emphasize the complex nature of famine mortality and suggest that a simple model of energy utilization alone is inadequate to explain the major aspects of this phenomenon.
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Liu Y, Lu J, Xu M, Xu Y, Li M, Wang T, Zhang J, Xu B, Sun J, Dai M, Bi Y, Wang W, Ning G. Association between history of abortion and nonalcoholic fatty liver disease in middle-aged and elderly Chinese women. Ann Epidemiol 2013; 23:119-23. [PMID: 23298439 DOI: 10.1016/j.annepidem.2012.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/16/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the possible relationship between self-reported history of abortion and nonalcoholic fatty liver disease (NAFLD) in middle-aged and elderly Chinese women. METHODS A cross-sectional study was performed in 5911 women aged 40 years or older in Jiading District, Shanghai, China. Reproductive histories, including miscarriage and induced abortion, were collected using a validated questionnaire by trained physicians. Abdominal B-mode ultrasound evaluation and serum liver enzymes levels were used in the diagnosis of NAFLD. RESULTS The percentage reporting history of abortion in women with NAFLD was higher than in those without NAFLD (72.4% vs. 69.3%, age-adjusted P = .001). Compared with women without a history of abortion, the fully adjusted odds ratio (OR) for NAFLD in those with a history of abortion was increased by 28% (OR, 1.28 and 95% confidence interval [CI], 1.06-1.55). Histories of miscarriage and induced abortion were also associated with increased risk of prevalent NAFLD in fully adjusted models (OR, 1.84 and 95% CI, 1.24-2.72; OR, 1.23 and 95% CI, 1.02-1.50, respectively). CONCLUSIONS Both miscarriage and induced abortion are associated with prevalent NAFLD in middle-aged and elderly Chinese women.
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Affiliation(s)
- Yu Liu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
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Susser E, Kirkbride J, Heijmans B, Kresovich J, Lumey L, Stein A. Maternal Prenatal Nutrition and Health in Grandchildren and Subsequent Generations. ANNUAL REVIEW OF ANTHROPOLOGY 2012. [DOI: 10.1146/annurev-anthro-081309-145645] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This review focuses on how maternal prenatal nutritional states may affect the health of grandchildren and later generations. We first summarize the limited current data in human populations relating to the potential transmission of phenotypes across multiple generations that result from the nutritional experience of a pregnant woman. We then discuss findings from other species, especially mammals, that provide important clues as to whether, and if so how, such transmission could occur in humans. Finally, we consider how studies of human populations could be best designed to detect transmission across multiple generations. We argue that just as epidemiologists embraced a life-course perspective to human health and disease in the twentieth century, we must now seek to better understand how health and disease could be shaped across multiple generations.
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Affiliation(s)
- E. Susser
- Imprints Center for Genetic and Environmental Life Course Studies, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - J.B. Kirkbride
- Imprints Center for Genetic and Environmental Life Course Studies, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
- EpiCentre, Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom
| | - B.T. Heijmans
- Molecular Epidemiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - J.K. Kresovich
- Imprints Center for Genetic and Environmental Life Course Studies, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - L.H. Lumey
- Imprints Center for Genetic and Environmental Life Course Studies, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - A.D. Stein
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322
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Da Li Q, Li H, Li FJ, Wang MS, Li ZJ, Han J, Li QH, Ma XJ, Wang DN. Nutrition deficiency increases the risk of stomach cancer mortality. BMC Cancer 2012; 12:315. [PMID: 22838407 PMCID: PMC3443031 DOI: 10.1186/1471-2407-12-315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/17/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of the study is to determine whether exposure to malnutrition during early life is associated with increased risk of stomach cancer in later life. METHODS The design protocol included analyzing the trend of gastric cancer mortality and nutrition and evaluating the association between nutrient deficiency in early life and the risk of gastric cancer by hierarchical age-period-birth cohort (APC) analysis using general log-linear Poisson models and to compare the difference between birth cohorts who were exposed to the 1959-1961 Chinese famine and those who were not exposed to the famine. Data on stomach cancer mortality from 1970 to 2009 and the dietary patterns from 1955 to 1985 which included the 1959-1961 Chinese famine period in the Zhaoyuan County population were obtained. The nutrition information was collected 15 years prior to the mortality data as based on the latest reference of disease incubation. RESULTS APC analysis revealed that severe nutrition deficiency during early life may increase the risk of stomach cancer. Compared with the 1960-1964 birth cohort, the risk for stomach cancer in all birth cohorts from 1900 to 1959 significantly increased; compared with the 1970-1974 cohort, the risk for stomach cancer in the 1975-1979 cohort significantly increased, whereas the others had a steadily decreased risk; compared with 85-89 age group in the 2005-2009 death survey, the ORs decreased with younger age and reached significant levels for the 50-54 age group after adjusting the confounding factors. The 1930 to 1964 group (exposed to famine) had a higher mortality rate than the 1965 to 1999 group (not exposed to famine). For males, the relative risk (RR) was 2.39 and the 95% confidence interval (CI) was 1.51 to 3.77. For females, RR was 1.64 and 95% CI was 1.02 to 2.62. CONCLUSION The results of the present study suggested that prolonged malnutrition during early life may increase the risk of stomach cancer mortality in later life.
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Affiliation(s)
- Qing Da Li
- Department of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Li
- Tumor Center, Qilu Hospital of Shandong University, Jinan, China
| | - Fu Ji Li
- Department of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Shu Wang
- Department of Epidemiology, College of Public Health of Shandong University, Jinan, China
| | - Zhuo Jian Li
- Center of Disease Control and Prevention of Jinan, Jinan, China
| | - Jing Han
- Department of Environmental Medicine, School of Medicine New York University, New York, USA
| | - Qing Hui Li
- Department of Epidemiology, Institute of Basic Medicine of Shandong Academy of Medical Sciences, Jinan, China
| | - Xiang Ji Ma
- Center of Disease Control and Prevention of Shandong Province, Jinan, China
| | - Da Nan Wang
- Center of Disease Control and Prevention of Zhaoyuan, Zhaoyuan, China
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Renzaho AMN. Mortality Rates, Prevalence of Malnutrition, and Prevalence of Lost Pregnancies among the Drought-Ravaged Population of Tete Province, Mozambique. Prehosp Disaster Med 2012; 22:26-34. [PMID: 17484360 DOI: 10.1017/s1049023x00004301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs.Objective:The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis.Methods:A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people.Results:Anthropometric data were collected among children 6–59 months of age. In addition, crude mortality rates (crude mortality rates), under five mortality rates (under 5 mortality rate), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI) = 6.2–9.8%) for acute malnutrition, 26.9% (95% CI = 24.0–29.9%) for being underweight, and 37.0% (95% CI = 33.8–40.2%) for chronic malnutrition. Boys were more likely to be under-weight than were girls (odds ratio (OR) = 1.34; 95% CI = 1.00, 1.82;p <0.05) after controlling for a, household size, and food aid beneficiary status. Similarly, children 30–59 months of age were significantly less likely to suffer from acute malnutrition (OR = 0.45; 95% CI = 0.26, 0.79; p <0.01) and less likely to be underweight (OR = 0.37; 95% CI = 0.27, 0.51;p <0.01) than children 6–29 months of a, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI = 4.5–11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10,000/day (95% CI = 1.08–1.38), and an under 5 mortality rate was 1.03/10,000/day (95% CI = 0.71–1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths.Conclusions:The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies.The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid program objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.
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Song S. Does famine influence sex ratio at birth? Evidence from the 1959-1961 Great Leap Forward Famine in China. Proc Biol Sci 2012; 279:2883-90. [PMID: 22456881 DOI: 10.1098/rspb.2012.0320] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The current study examined the long-term trend in sex ratio at birth between 1929 and 1982 using retrospective birth histories of 310 101 Chinese women collected in a large, nationally representative sample survey in 1982. The study identified an abrupt decline in sex ratio at birth between April 1960, over a year after the Great Leap Forward Famine began, and October 1963, approximately 2 years after the famine ended, followed by a compensatory rise between October 1963 and July 1965. These findings support the adaptive sex ratio adjustment hypothesis that mothers in good condition are more likely to give birth to sons, whereas mothers in poor condition are more likely to give birth to daughters. In addition, these findings help explain the lack of consistent evidence reported by earlier studies based on the 1944-1945 Dutch Hunger Winter or the 1942 Leningrad Siege.
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Affiliation(s)
- Shige Song
- Queens College and CUNY Institute for Demographic Research, City University of New York, Flushing, NY 11367, USA.
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Zhao Z, Reimondos A. Démographie de la famine de 1958 à 1961 en Chine : une nouvelle analyse. POPULATION 2012. [DOI: 10.3917/popu.1202.0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Zheng X, Wang Y, Ren W, Luo R, Zhang S, Zhang JH, Zeng Q. Risk of metabolic syndrome in adults exposed to the great Chinese famine during the fetal life and early childhood. Eur J Clin Nutr 2011; 66:231-6. [DOI: 10.1038/ejcn.2011.161] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
This study examines the effects of birth month and socioeconomic factors on height in rural Chinese men. The analysis of sample data of 833 adult men, 18-52 years of age, collected from 600 families in rural Hebei in 2005, shows that adult men born in winter months (November to January) are, on average, 1.04 cm shorter (p<0.01) than those born during the rest of the year. In addition to the conventional OLS regression models, the household fixed and random effects models also indicate that the month-of-birth effect exists when socioeconomic variables are controlled for. The birth-month effect on height is, however, smaller than effects of socioeconomic variables, including the household registration status, household economy and father's class status.
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Abstract
We review human studies on the relation between acute exposures to prenatal famine and adult physical and mental health. These studies are observational and include exposures to a famine environment by natural or man-made causes or, more commonly, from the interplay between natural and human factors. These natural experiments provide an opportunity to examine long-term outcomes after famine exposures by comparing exposed and nonexposed individuals. The studies show consistent associations between prenatal famine and adult body size, diabetes, and schizophrenia. For other measures of adult health, findings are less robust. A relation between prenatal famine and some reported epigenetic changes may provide a potential mechanism to explain specific associations. Much progress can be made if current separate studies are further analyzed with comparable definitions of exposures and outcomes and using common analytic strategies.
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Affiliation(s)
- L H Lumey
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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Mu R, Zhang X. Why does the Great Chinese Famine affect the male and female survivors differently? Mortality selection versus son preference. ECONOMICS AND HUMAN BIOLOGY 2011; 9:92-105. [PMID: 20732838 DOI: 10.1016/j.ehb.2010.07.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 07/22/2010] [Accepted: 07/22/2010] [Indexed: 05/29/2023]
Abstract
Evidence shows that exposure to nutritional adversity in early life has larger long-term impacts on women than on men. Consistent with these findings, our paper shows a higher incidence of disability and illiteracy among female survivors of the Great Chinese Famine (1959-1961). Moreover we find that the better health of male survivors most plausibly reflects higher male excess mortality during the famine, whereas the observed gender difference in illiteracy rate is probably better explained by the culture of son preference.
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Affiliation(s)
- Ren Mu
- Bush School of Government and Public Service, Texas A&M University, 4220 TAMU, College Station, TX 77843, USA.
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Song S. Mortality consequences of the 1959–1961 Great Leap Forward famine in China: Debilitation, selection, and mortality crossovers. Soc Sci Med 2010; 71:551-558. [DOI: 10.1016/j.socscimed.2010.04.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 03/15/2010] [Accepted: 04/30/2010] [Indexed: 11/24/2022]
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Through Civil War, Food Crisis and Drought: Trends in Fertility and Nuptiality in Post-Soviet Tajikistan. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2010. [DOI: 10.1007/s10680-010-9206-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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